Celebrating primary care by telling stories

Personal narratives bear witness to everyday successes

By Sandra Gray,

UMass Medical School Communications

October 14, 2011

Photos by Rob Carlin

UMass Worcester Family Medicine Residency Director Stacy Potts, MD, reads her story about the joys of maternal and child care at “Celebrating Primary Care Storytelling,” held in honor of National Primary Care Week.

Because primary care providers care for people at all ages—from birth to death and every other point along life’s continuum—they have the opportunity to learn valuable lessons about humanity from their patients. Some of those lessons have been captured in writing through Thursday Morning Memos, the Department of Family Medicine & Community Health’s weekly narrative medicine series.

To mark National Primary Care Week at UMass Medical School, on Wednesday, Oct. 5, the Lamar Soutter Library’s Humanities in Medicine Committee and the Massachusetts Area Health Education Centers Network hosted “Celebrating Primary Care Storytelling,” readings of Thursday Morning Memos by the primary care physicians and physicians-in-training who wrote them.

Originated at UMMS by Hugh Silk, MD, associate professor of family medicine & community health, Thursday Morning Memos is UMass Medical School’s version of narrative medicine, in which students, residents and faculty of the department and, sometimes, other primary care departments, reflect on outcomes, honor relationships and explore meaning in their work through writing about their experiences with patients. Like the practice of family medicine itself, primary care stories span the gamut of life experiences, from profound to mundane. Acknowledging successes while considering what they might do differently next time can also help refresh and fortify the writers for the difficult work they do day in and day out.

“Through Thursday Morning Memos, Hugh Silk has managed to take humanities in medicine and make it a concrete and everyday practice for primary care physicians at UMMS,” said Ellen More, PhD, professor of psychiatry and head of the Soutter Library’s Office of Medical History and Archives, in her opening remarks for the event.

Dr. Silk continues work to expand Thursday Morning Memos to other departments at UMMS and, ultimately, to other medical schools. Now in the habit of encouraging submissions at every opportunity he gets, he explained, “All of us have at least one story a day.”

The following excerpts from the evening’s readers highlight just a few of those stories.

Stacy Potts, MD, assistant professor of family medicine & community health and director of the UMass Worcester Family Medicine Residency, shared her passion for being present at births, each unique but perfect in its own way.

“Family-centered maternity care is the piece of my practice that brings me the most excitement and rewarding experiences of any clinical activity. For me, the unique, literally once in a lifetime, labor and delivery experience is astonishing every time . . . Maternity care is more than the mechanics of getting the baby out. It is about making this unique experience a wonderful memory for the patient and family. ”

In her essay called “Photographs,” third-year resident Katrina Austria, MD, learned something about family life when she visited a patient nearing death.

“For me, photographs serve to remind me that my patient is a person, and exists in a special light for her or her family and friends . . . we went to Mrs. T’s bedside . . . she did appear small, weak and quiet . . . The Mrs. T in the photos was a more robust, life-loving, smiling, vibrant woman . . . This is the Mrs. T that they still hold in their hearts, the Mrs. T they wish they could have forever . . . It reminds us as physicians that we are not only caring for the patient, but also for the people who hold the patient close in their hearts.”

Melinda Raboin, MD, a Hahnemann Family Health Center residency graduate now in private practice near her home, read about making house visits part of her practice when the need for them arises, as when a patient about to go into hospice care died unexpectedly in the night.

“Ruth had died comfortably . . . We talked, they cried, told more stories . . . Before too long I was signing the death certificate on the kitchen table, and Ruth’s body was going out in a neatly prepared body bag on a gurney. All of this felt so powerful to me, yet so simple. After hugs and goodbyes and thank yous, I was back in my car going home . . . I felt good about my house call, about being a hometown doc, about being out in the middle of the night to take part in a family life event.”

A poem by Anita Kostecki, MD, family physician at the Edward M. Kennedy Community Health Center in Worcester, captured the intensity of when the time between birth and death is shortest.

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There is a moment when 15 minutes of searching with a Doppler becomes just a second When the mother’s first desperate scream is only a faint echo When the pounding of the father’s fists on the walls stills When the initial tears flow into all the other tears and stop as if dammed When the grandmother’s pointed finger recoils, and her ugly words are silenced

. . .When there is nothing else to do

There is a moment when all else finally ceases and two parents gaze raptly at the face of their infant for just one brief second. They stand in quiet wonderment, taken aback at the beautiful spirit shining so clearly out of their dead baby. They appear stunned at the gift they are being given in the midst of such devastating grief.

Not just life and death, family medicine is also about small steps and slow but steady progress with long-term problems. Pediatrician Jennifer Bram, MD, assistant professor of pediatrics, celebrated such small victories in her piece about treating a young woman with a difficult diagnosis.

“At the end of the visit I voiced my concern that “M” might have an eating disorder. Any hope of rapport with this patient evaporated into thin air. I received an icy stare in return for my look of concern . . . and so began my journey with M and her family in treating her anorexia . . . I wanted to connect with her and let her know that I cared, but got no response . . . after many appointments I found myself wondering if she would be better served by a physician with more experience with eating disorders and adolescents . . . When she came to my office for the first time after her hospitalization, I saw a crack in her hard shell. She had gained weight, she looked healthier, and she was glad to be home. Once again, I tried to let her know that I was there to help her. She smiled. I felt it was the start of something. I wish I could say at the end of this story that M is fully recovered. Unfortunately, she is still fighting her battle with anorexia. The difference is that now we are fighting it together . . . I never made a dramatic breakthrough or an amazing medical discovery . . . slowly but surely, visit after visit, I gained her trust. That is a victory that I savor even as the battle rages on.”